Authors: Richard Kluger
That inability to fix sure blame on smokeless as a lethal causative agent doomed the plaintiffs case in the Marsee trial, played out in an Oklahoma federal court soon thereafter. The courtroom proceedings were notable for defendant UST’s supreme disdain for the rest of society’s concern about the health hazards of tobacco products. Company officials unapologetically noted that they had not looked into the dangers of nitrosamines until 1984; the vice president in charge of research claimed not to know what a carcinogen was or the meanings of the words “safety” and “danger” in the context of how tobacco might relate to health, and the former chief executive of UST remarked at one point, “I am not aware that anyone has said that snuff causes cancer,” adding that it was not his company’s policy—massive evidence to the contrary notwithstanding—to market smokeless tobacco to teenagers. The jury was not convinced that young Marsee had died from using the product and found for UST
“These are very evil people,” Gregory Connolly said of tobacco industry executives a few years after his legislative triumphs over smokeless had whetted his appetite for the antismoking (and antichewing and antidipping) fray. Tobacco in its manufactured form, he said, “has got to be prohibited eventually.” Connolly would go on to play an important role, as an advisor to international tobacco control efforts, in the outlawing of smokeless throughout Western Europe, and by the mid-’Nineties was running the new Massachusetts office on smoking control with an annual budget, derived from a stiff state cigarette
tax approved by referendum, of nearly $60 million, bigger than the entire federal effort.
IX
THE
new breed of antismoking activists, while well trained in the physical and social sciences, made their contribution not in laboratories or legislative corridors but at the barricades as unabashed agitators against an entrenched foe, as self-styled dragonslayers who used words as their cutting weapon. One of the best and most incessant of them was Amherst man Alan Blum, a deft writer and arresting speaker, who, at the age of thirty while a resident in family medicine at the University of Miami, launched Doctors Ought to Care (DOC) as a vehicle to combat the smoking scourge.
The son of a heavy-smoking physician who had suffered a heart attack in his early forties, Blum had become fascinated with and sickened by old cigarette advertisements, in particular those that employed pseudo-scientific claims and white-coated models to persuade the public that smoking was harmless. He collected an archive on the subject and grew convinced that the industry’s sales technique was “aimed virtually entirely at children to gain their social acceptance of the product.” And while he saw the point of pushing for clean indoor air laws and higher cigarette taxes, he thought such measures primarily punished smokers, who were the wrong target. A specialist in family medicine, Blum had a more direct expedient in mind: “I’d put the manufacturers in jail—for going after the kids—on a child molestation ground.”
There was only a small element of hyperbole in his satiric onslaught against what he came to view as a savage industry, let off the hook far too easily and “laughing all the way to the bank in a society that finds it of at best tangential interest that their product kills so many every year—which is why I’m a revolutionist and obsessive on this subject.” In organizing DOC, a loose alliance of medical practitioners who shared his distress over this neglected killer and were willing to alert their communities to it, Blum sought to fight back by using the industry’s own weapons. He applied dues money and other contributions to DOC to buying billboards and signs on benches at bus stops and led picketers with placards that unsubtly lampooned cigarette ads
(e.g.
, “You’ve coughed up long enough, baby. Emphysema Slims,” and “Benson & Hedges Destroys Healthy Bodies 12 Ways”) and then turned to advocacy journalism, practiced largely in professional publications. As an AMA Fellow in medical journalism, he produced a cutting commentary in the February 22, 1980,
JAMA
entitled “Medicine vs. Madison Avenue,” in which he shredded the tobacco companies for their claim that it was not advertising that sold cigarettes to youngsters but peer pressure; Blum noted that “peer pressure can be
bought, as any rock music impresario, toy maker or market research expert will corroborate … .”
Blum raged particularly at the professional sports community, which he thought ought to place physical well-being on a pedestal but instead seemed to be in cahoots with the cigarette makers by leasing them advertising space in their stadiums and arenas where youthful spectators could not miss the message. Not only did almost every major league ballpark have a giant cigarette billboard, Blum pointed out, but they were artfully positioned for maximum exposure during telecasts of the games, like the one at Shea Stadium in New York which filled almost the entire backdrop when the field-level camera showed a runner leading off first base. This practice was, for Blum, “in violation of the law against showing cigarette advertising on television;” that the manufacturers were paying someone other than the broadcasting companies to deploy their signage did not alter the effect of nose-thumbing at a federal prohibition.
Battling the tobacco industry became the dominant mission in Blum’s life. He traveled wherever he was welcomed to give witty talks and slide shows vilifying the purveyors, wrote cogently vituperative articles and letters to the editor, and appeared on talk shows, as if single-handedly trying to instruct the nation about what truly imperiled its collective health. As he wrote in the 1982 annual edition of the
Encyclopedia of Preventive Medicine:
“Public outcry (egged on by banner headlines) over a mere handful of cases of botulism, toxic shock syndrome, or Legionnaires’ disease can close businesses. One million cars can be recalled because of one death due to a malfunction of a single automobile. Yet newspapers run full-page advertisements for the product that has been described by the World Health Organization as the single most preventable cause of death and disability.”
But Blum spoke loudest and most compellingly to his fellow practitioners through DOC, using its newsletter and member meetings to lament, for example, that not one of the 9,000 courses listed in the catalogues of U.S. medical schools was devoted to the treatment or prevention of smoking and that seldom was it a topic dealt with on grand rounds at teaching hospitals. Doctors, he argued, ought to mentor their younger patients on the perils of smoking by stressing not the ultimate price they might pay for it but the social unattractiveness of “zoo breath” and the impairment of their athletic skills; to quit smoking themselves and ban it from their waiting rooms, along with magazines they subscribed to that carried cigarette ads; to urge hospitals with which they were affiliated and pharmacies they dealt with not to dispense cigarettes; and to send a postcard black-edged for bereavement to the congressman of every patient who died from a smoking-related disease.
Blum’s crowning, and ultimately self-immolating, editorial feat came when he was named in 1983 to edit the
New York State Journal of Medicine
and
devoted the entire contents of its December issue that year to “The World Cigarette Pandemic.” Normally a conservative academic publication, the magazine—for one issue—turned into a grab bag of fire-breathing pieces on the biochemical, political, economic, legal, and ethical aspects of tobacco use, attracting contributions from five Surgeon Generals, former HEW Secretary Califano, and leading investigators and public-health activists in the field. Although very uneven, the issue was lively and full of unfamiliar items, like the calculation that Americans spent 40 percent as much on cigarettes as they did on buying cars, the advisory that
The New York Times
and Time Inc. bought space in the tobacco trade press thanking the industry for its advertising patronage, and the disclosure that fully one-quarter of Philip Morris’s stock was held by banks, suggesting how intimately the cigarette companies had been consorting with the financial as well as the political establishment. The cumulative effect of this special issue was “stunning,” in the opinion of the
Columbia Journalism Review,
and showed what the mainstream press could have done if it had truly wanted to explore the tobacco story.
Having made his point, Blum was incapable of leaving off. He devoted a second issue, in June 1985, of his journal to the same subject, this time concentrating on the international aspects of tobacco exploitation—a topic rarely written about—and had so much material left over that he was preparing a third special issue when he was summoned the day after Christmas 1985 and summarily fired without severance. His superior, by way of explanation, told him only, “I don’t like your journal,” Blum recounted, but conceded that he had come to be viewed as a zealot on smoking and thus an unsound choice to run such a publication. But he continued, at considerable personal expense, to hector the industry. He bought a single share of Philip Morris stock, for instance, and made a point of showing up at the company’s annual meetings to protest practices that he found unforgivable, such as exporting cigarettes without health warnings on the pack to developing countries that did not require them. Never subdued or deferential to critics who found him almost pathetically eager to be credited with the growth of antismoking sentiment he had in fact done much to foment, Blum invested still more of himself in building DOC even while holding a tenured place on the Baylor medical faculty in Texas.
A less flamboyant antismoking crusader, befitting her conservative political views, was Elizabeth M. Whelan. With a master’s degree in public health from Yale and a doctorate from Harvard, she wrote widely for popular consumption on diet, child care, and other health matters during the ’Seventies but found that whenever she dealt with tobacco, her prose was toned down by editors. If she termed smoking a serious hazard, for example, the reference might be fixed to read “very, very heavy smoking,” or cut out altogether. Such indulgence by editors, with an eye to a major source of their magazines’ advertising,
led to what Whelan considered “an incredible inversion of priorities,” as irritants like red dye No. 2 and air pollution were blown into major health perils by the media, and cigarettes were all but exonerated. “The elephants were running wild,” she reflected, “while we were busy crushing the ants.”
In 1978, when she was thirty-five, Whelan enlisted the backing of famed Harvard nutritionist Fredrick Stare, a former professor of hers, and other academic eminences to open her own enterprise, somewhat grandly called the American Council on Science and Health, devoted to educating consumers. Funded by non-profit foundations and decidedly profit-seeking corporations, some in the food business, opening Whelan to conflict-of-interest charges, her office generated studies, pamphlets, reports, and a newsletter that were clear, informative, and objective. From the first, smoking was one of her council’s major concerns, as she kept after the subject in ways others ignored by writing in her newsletter,
Healthwatch
, on, for example, the inadequacy of the cigarette companies’ disclosure of the additives in their manufacturing process and how the U.S. government had long been guilty of pushing surplus American tobacco in Third World nations in the guise of economic aid.
Because she felt that her fellow conservatives suffered from a “complete inability to deal effectively with cigarettes” due to their doctrinaire distaste for government intervention in matters best left to private resolution, Whelan reached out to them, in part through articles in
The Wall Street Journal
. A particular source of sadness to her was that many conservatives were avowedly “pro-life” in their opposition to abortion but seemingly anti-life in their failure to combat the hazards of smoking. Whelan’s most noteworthy effort was a sustained but not shrill diatribe in book form—
A Smoking Gun: How the Tobacco Industry Gets Away with Murder
—issued in 1984 by a small Philadelphia publisher. The most stinging volume on the subject by an American since Senator Maurine Neuberger’s
Smoke Screen
twenty-one years earlier, it blended history and analysis of the cigarette companies’ conduct, which she called “a unique problem that demands a unique solution,” yet feared it would not be addressed because “Americans today do not want to talk about cigarettes.” In a chapter entitled “Fourteen Ploys That Can Kill You,” she battered most of the industry’s pet defenses, such as the claim that the health charges against it were merely an association of factors and did not prove causation. The companies, she wrote, “would have us believe that statistics are just a group of numbers looking for an argument.”
x
DURING
the congressional testimony by health advocates on the 1984 cigarette labeling bill, no organization was more conspicuous by its absence
than the group widely regarded as the voice of the American medical profession—the AMA—with more than 300,000 physicians, over half the national total, as members. AMA policy in tolerance of smoking had for decades been a notorious example of self-serving cynicism in the eyes of those who felt that doctors were, or ought to be, exemplars of altruism.
Practitioners in a high-stress profession, many physicians had been heavy smokers. Industry-manned tables distributing free cigarettes were a fixture at medical meetings and conventions throughout the first half of the century and beyond, and if doctors did not openly condone smoking by their patients, they were slow to denounce it. The AMA had been particularly dilatory in this regard, indeed unconscionably so. At the first congressional hearings on smoking and health in 1957, its spokesman contended that a man would have to inhale 100,000 cigarettes a day to absorb a dose equivalent to what was being painted on the shaved backs of mice in bioassays to test the carcinogenic potency of tobacco. The AMA leadership had opposed the health warning labels on cigarette packs seven years later, when Congress first seriously considered the idea, and then allowed the tobacco industry to buy time and the AMA’s good name in its abortive fourteen-year study of the hazards of smoking—part of the crass exchange for winning protobacco lawmakers’ opposition to Medicare.